Abstract
Background: This study investigated whether the empirical dietary inflammatory index (eDII) score is associated with the inflammatory burden as well as the depressive status in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Methods: Eighty-four patients with AAV participated in this study. Birmingham vasculitis activity score (BVAS) and short-form 36-item Health Survey mental component summary (SF-36 MCS) were considered as indices assessing the inflammatory burden and depressive status, respectively. The eDII includes 16 food components and consists of three groups: −9 to −2, the low eDII group; −1 to +1, the moderate eDII group; and +2 to +10, the high eDII group. Furthermore, the lower eDII group includes both the low and moderate eDII groups. Results: The median age was 64.5 years (36 men). The eDII scores inversely correlated with SF-36 MCS (r = −0.298, p = 0.006) but not with BVAS. SF-36 MCS significantly differ between the lower and higher eDII groups (69.7 vs. 56.7, p = 0.016), but not among the low, moderate and high eDII groups. Additionally, when patients with AAV were divided into two groups according to the upper limit of the lowest tertile of SF-36 MCS of 55.31, patients in the higher eDII group exhibited a significantly higher risk for the lowest tertile of SF-36 MCS than those in the lower eDII group (RR 3.000). Conclusion: We demonstrated for the first time that the eDII could predict the depressive status by estimating SF-36 MCS without utilising K-CESD-R ≥ 16 in patients with AAV.
| Original language | English |
|---|---|
| Article number | e24543 |
| Journal | Journal of Clinical Laboratory Analysis |
| Volume | 36 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 2022 Jul |
Bibliographical note
Funding Information:This research was supported by a faculty research grant from Yonsei University College of Medicine (6–2019‐0184) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (HI14C1324)
Funding Information:
The participants were randomly selected from those who were enrolled in the Severance Hospital ANCA-associated VasculitidEs (SHAVE) cohort and who agreed to participate in the study. The SHAVE cohort is a prospective and observational cohort, which began in November 2016, and includes patients with MPA, GPA or EGPA. AAV diagnosis in all participants was confirmed at the Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine and Severance Hospital. All participants fulfilled both the revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides proposed in 2012, and the 2007 European Medicines Agency algorithms for AAV.11,12 During study enrolment, the patients were followed up for at least 3 months and had no concomitant serious medical conditions resulting in ambiguity in interpreting the results, such as malignancies and infectious diseases requiring hospitalisation.14,18 Although 89 patients with AAV volunteered to participate and provided informed consent, two patients were excluded due to concomitant serious infectious diseases and three patients due to consent withdrawal. Finally, 84 patients with AAV were included in this study. This study was approved by the Institutional Review Board of Severance Hospital (4–2016-0901) and conducted according to the Declaration of Helsinki. The patients' written informed consent was obtained from all patients. The participants were randomly selected from those who were enrolled in the Severance Hospital ANCA-associated VasculitidEs (SHAVE) cohort and who agreed to participate in the study. The SHAVE cohort is a prospective and observational cohort, which began in November 2016, and includes patients with MPA, GPA or EGPA. AAV diagnosis in all participants was confirmed at the Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine and Severance Hospital. All participants fulfilled both the revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides proposed in 2012, and the 2007 European Medicines Agency algorithms for AAV.11,12 During study enrolment, the patients were followed up for at least 3 months and had no concomitant serious medical conditions resulting in ambiguity in interpreting the results, such as malignancies and infectious diseases requiring hospitalisation.14,18 Although 89 patients with AAV volunteered to participate and provided informed consent, two patients were excluded due to concomitant serious infectious diseases and three patients due to consent withdrawal. Finally, 84 patients with AAV were included in this study. This study was approved by the Institutional Review Board of Severance Hospital (4–2016-0901) and conducted according to the Declaration of Helsinki. The patients' written informed consent was obtained from all patients. All data were collected at the time of informed consent provision, filling out the eDII and SF-36 questionnaires, assessing AAV-specific indices and performing blood tests. The demographic data included age and sex. Regarding the AAV-related variables, the AAV subtype, ANCA positivity status, AAV-specific indices and clinical manifestations were recorded. In terms of acute-phase reactants reflecting the inflammatory status, erythrocyte sedimentation rate (ESR) and CRP levels were investigated along with routine laboratory tests.14,18 Medications which were currently administered at the time of this study were also assessed. The SF-36 MCS and SF-36 physical component summary (PCS) scores were considered as a functional status index,16 Birmingham vasculitis activity score (BVAS) as a vasculitis activity index,19 and vasculitis damage index (VDI) as a damage index.20 In particular, SF-36 MCS and BVAS were considered as indices assessing the inflammatory burden and depressive status, respectively. Myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA were measured using the novel anchor-coated highly sensitive Phadia Elia (Thermo Fisher Scientific/Phadia, Freiburg, Germany) and human native antigens, using Phadia250 analyser. Immunoassays were used as the primary screening method for ANCA; however, when patients tested negative for ANCA by an antigen-specific assay but positive for perinuclear (P)-ANCA or cytoplasmic (C)-ANCA by an indirect immunofluorescence assay, they were considered to have MPO-ANCA or PR3-ANCA when AAV was strongly suspected based on the clinical and laboratory features.21 In the eDII, red meat, processed meat, organ meat, other fish, eggs, sugar-sweetened beverages, tomatoes, white rice and bread/noodles are considered pro-inflammatory foods. On the contrary, leafy green vegetables, dark yellow vegetables, fruit juices, oily fish, coffee, tea, wine, beer or other alcoholic beverages are considered anti-inflammatory foods. Differentiated scores are assigned from 0 to +2 and from −2 to 0 according to the frequency of consumption of pro-inflammatory foods and anti-inflammatory foods, respectively. The higher eDII score, the greater the inflammation.17 Patients were divided into three groups according to the eDII scores: −9 to −2, the low eDII group; −1 to +1, the moderate eDII group; and + 2 to +10, the high eDII group.17 All statistical analyses were performed using IBM SPSS Statistics for Windows version 26 (IBM Corp.). Continuous variables are expressed as medians with interquartile ranges, whereas categorical variables are expressed as numbers (percentages). The correlation coefficient (r) between the two variables was obtained using either the Pearson correlation analysis. Significant differences between two continuous variables were compared using the Mann–Whitney U test. Significant differences among more than three continuous variables were investigated using the Kruskal–Wallis test. The relative risk (RR) was analysed using contingency tables and the chi-square test. p-values less than 0.05 were considered statistically significant.14
Publisher Copyright:
© 2022 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.
All Science Journal Classification (ASJC) codes
- Immunology and Allergy
- Hematology
- Public Health, Environmental and Occupational Health
- Clinical Biochemistry
- Medical Laboratory Technology
- Biochemistry, medical
- Microbiology (medical)
